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[Echocardiographic relation criteria. A new selection method for mitral valvotomy with balloon catheter]
J A Mangione1, M A Lopes, A A Salman
1Hospital Beneficência Portuguesa de São Paulo, Servico S. Ariê.
Insights
Selecting patients for mitral balloon valvotomy requires careful consideration. The echocardiographic relation criteria (ERC) can help identify suitable candidates among those scoring 9-12 points using Block's Criteria.
Area of Science:
- Cardiology
- Interventional Cardiology
- Echocardiography
Background:
- Mitral balloon valvotomy is a procedure for mitral stenosis.
- Patient selection is crucial for successful outcomes.
- Block's Criteria and echocardiographic assessment are used for evaluation.
Purpose of the Study:
- To identify new criteria for selecting patients with 9-12 points on Block's Criteria for mitral balloon valvotomy.
- To evaluate the utility of echocardiographic relation criteria (ERC) in this patient group.
Main Methods:
- 140 patients underwent mitral balloon valvotomy.
- 29 patients (21%) scored 9-12 points on Block's Criteria.
- Patients were divided into two groups based on post-procedure mitral valve area and follow-up.
- Echocardiographic relation criteria (ERC) were used, assessing calcification, subvalvar disease, and mobility.
Main Results:
- Group A (mitral valve area >= 1.5cm2) had 17 patients; Group B (<1.5cm2) had 12 patients.
- Group A showed stable mitral valve area post-procedure and during follow-up.
- Group B showed an initial increase in mitral valve area, followed by a significant decrease during follow-up.
- All Group A patients had ERC < 1, while 83% of Group B had ERC >= 1.
Conclusions:
- Patients scoring 9-12 points on Block's Criteria represent a heterogeneous group.
- Individual patient assessment is necessary for mitral balloon valvotomy selection.
- Echocardiographic relation criteria (ERC) are valuable for selecting these patients.
Purpose:
To find out new subjects that could be useful to select patients between 9 and 12 points, according to Block's Criteria, to mitral balloon valvotomy.
Methods:
One hundred and forty patients underwent mitral balloon valvotomy. Among them, 29 (21%) had between 9 and 12 points. These patients were divided into two groups: group A-patients with mitral valve area > or = 1.5cm2, immediately after balloon valvotomy and in the follow-up period; group B-patients with mitral valve area < 1.5cm2 immediately after or during the follow-up period, patients with severe mitral regurgitation after the procedure and patients who died in the follow-up period. All patients were analyzed by echocardiographic relation criteria (ERC): calcification + subvalvar disease/thickness + mobility. Each one was quantified from 1 to 4 points according to the degree of valvular disease.
Results:
Group A was composed of 17 (51%) and group B 12 (41%) patients. The variables age, sex, previous mitral commissurotomy and atrial fibrillation did not show difference between groups. In group A mitral valve area (cm2) increased from 1.15 +/- 0.25 to 1.97 +/- 0.26 (p < 0.00001) keeping stable during the follow-up period. In group B percutaneous mitral balloon valvotomy resulted in an increase from 1.26 +/- 0.19 to 1.77 +/- 0.16 (p < 0.00001), however, there was an important decrease in the follow-up period to 1.34 +/- 0.15 (p < 0.00001). The ERC showed that all group A patients had a relation < 1. However, in group B, 10 patients (83%), the relation was > or = 1, and in only 2 patients (17%) was < 1 (p < 0.00001).
Conclusion:
The group of patients between 9 and 12 points in the Block's criteria is heterogenic, therefore, each case might be evaluated individually and the echocardiographic relation criteria should be used in order to select these patients to the procedure.